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principally brought on by suckling her child too long, which was the cause that had produced it before. Słe was living with her husband, and had the charge of this girl, of about fifteen, who lay in bed all day; she was very kind to her, and had treated her very well; they were miserably poor, and very much owing to that, she continued to nurse her boy till he was nearly two years old ; and suddenly, when in this state, she, one morning, about eleven o'clock, went to the child lying in bed, aged fifteen, and deliberately cut her throat; then she went towards her own child, a girl of five or six years of age, of whom she was exceedingly fond, and the girl hearing a noise, looked up and said: “What are you doing?” “I have “ killed Olivia, and I am going to kill you,” was the answer. The child, fortunately, instead of screaming, threw her arms round her mother's neck and said: “No, I know you would not hurt your little Mopsy.” The woman dropped the child, went down and told a neighbour what she had done, that she “had killed Olivia, and was going to kill Mary ; but when the darling threw its arms round my neck, I had not the heart to do it.” She clearly knew right from wrong, and knew the character of her act. For some little time after that she talked rationally enough, but before night she was sent to a lunatic asylum raving mad, and having recovered she was brought to be tried before me at a subsequent Assize. She did know the quality of her act, and was quite aware of what she had done, but I felt it impossible to say she should be punished. If I had read the deposition in Magnantin's case, and said: “Do you bring her within that ?” the jury would have taken the bit in their own teeth, and said, “ Not guilty on the ground of insanity,” and I think rightly. She is well borne out by the following extract made from a statement sent to the Committee by the Lord Chief Justice of England (Sir A. Cockburn): “As the law as expounded by the Judges in the House of Lords now stands, it is only when mental diseases produce incapacity to distinguish between right and wrong that immunity from the penal consequences of crime is admitted. The present bill introduces a new element, the absence of power of self denial. I concur
most cordially in the proposed alteration of the law, having been always strongly of opinion that, as the pathology of insanity abundantly establishes, there are forms of mental disease in which, though the patient is quite aware he is about to do wrong, the will becomes overpowered by the force of irresistible impulse, the power of self control when destroyed, or suspended, by mental disease becomes, I think, an essential element of responsibility.”
In the July number of the same journal (1875), page 258, is the following from the pen of Dr. Bucknill: “Responsibility depends upon power and not upon knowledge and feeling, and a man is responsible to do that which he can do ; not that which he feels, or knows it right to do.”
Well, gentlemen, no matter how you, or others, may differ with me respecting a criminal neurosis, and that a man's moral responsibility depends upon his mental organization, there are none of you, with such authority on my side as I have quoted for you, but will agree with me, that it is full time for us to have legislation upon responsibility in the insane. And that law should decide, as it has in England, that a person may know the difference between right and wrong, and yet be irresponsible for their acts, their will being overpowered, and their self control destroyed by the force of irrisistible impulse. Yes, it surely is time that this important question should be settled ; it is time that the law should define where irresponsibility ends, and responsibility begins.
I have brought this evening, before you three distinct subjects for consideration. The first, as to how the Medical Schools shall provide means to give students clinical instructions upon mental diseases. Well, gentlemen, if your different Professors will come to some understanding amongst themselves, I will be happy to aid you in carrying out your plans. The second subject is with regard to the criminal class of society; strong as my convictions are upon the unscientific treatment of this class of society, I would not ask you to take any move in the matter at present. There are too strong prejudices to overcome ; better wait till the people are better instructed in science, pressI ask you
ing the question at present would do more harm than good, at least that is my opinion. But with regard to the third subject, viz., to urge upon the Legislature the necessity of legislating on the subject of responsibility and irresponsibility in the insane. if you agree with me,
that we require such legislation, to prepare petitions to the Legislature praying for legislation, and setting forth the reasons why our prayer should be acceded to. In fact that the law should be," that a man is responsible for what he can do, not for that which he feels, or knows, it right to do.” Or, gentlemen, if you see any more simple way to bring the matter before the Legislature, do so,; but do something, if it were only to show, as scientists, we are alive to the necessity of some change being made in the law of lunacy.
MEDICAL AND SURGICAL CASES OCCURRING IN THE PRACTICE (F THE
MONTREAL GENERAL HOSPITAL.
Case of Compound Comminuted Fracture of Leg.–Amputa
tion with Antiseptic precautions.—Recovery.—Under the care of DR. RODDICK.
(Reported by Mr. J. A. MCARTHUR.)
J. O. M., laborer, æt 22, a strong healthy young man of good physique, was admitted into the Montreal General Hospital, Oct. 8th., 1878, with compound, comminuted fracture of left leg, the result of direct violence. His family and personal history are good.
The history of the accident is briefly as follows:
In the afternoon of above date the patient, with others, was engaged on ship board, hoisting a heavy plate from the hold of a steamer. It appears that when elevated about ten feet above patient's head, the chain sling attached to the plate lost its catch, the latter fell suddenly to the floor before sufficient time was given to get out of its way; and, from the nature of the accident, probably struck the limb directly with its edge.
On examination, (one hour after occurrence of accident) the
left leg is found crushed to a fearful extent, especially at a point corresponding to the lower part of middle third. Here a large area of surface is broken on either side, the soft parts greatly contused and lacerated, and the bones badly comminuted. Distal part of limb is cold and pulseless and freely movable in any direction, Tibia is broken into five or six small irregular pieces partly or wholly denuded of periosteum. The fibula is fractured at two points, probably about four inches from either extremity, the lower one being compound, the upper one not so, but isolated, as it were, from the common site of injury. He feels weak, and depressed ; is slightly feverish; temp. 99.5° in axilla ; pulse 85, small and soft ; hemorrhage not over great.
At 5.30 P. M.. ether was given, and Dr. Roddick, assisted by the house surgeons, proceeded to remove the limb, Lister's antiseptic method being carried out to its fullest extent. The site chosen for amputation was a point about six inches below the knee, in close proximity to the lacerated parts, and within half an inch of the upper fibular fracture. The method adopted was a modified flap, the anterior flap made long by dissection, the posterior, short, and by transfixion. Esmarch's band was used to control hemorrhage. There was considerable difficulty in securing the vessels, and stopping primary oozing from the stump. The flaps were secured by catgut sutures, and the whole carefully inclosed in the Antiseptic Dressing.
9 P. M.—The patient is weak and depressed. Temp. 101o. Pulse, 92 ; suffers considerable pain ; no inclination to sleep.
Oct. 9th., 12.30 P. M.—Passed a restless night; much pain in stump; morning, temp. 99o ; everything looking nicely, and fresh dressing applied.
10th.-Spent a fairly good night. Not much pain. Temp. 101o. Dressings are quite sweet. Stump looks well. A little oozing, chiefly serous. No inflammatory tension, dressed as before.
13th.—Spent a good night ; feels comfortable, and is cheerful ; temperature 100°; stump dressed as usual ; looks very well ; union seems to be progressing favorably; discharge
altogether serous; no bagging of pus, or tension anywhere; no signs of lymphatic trouble. Bowels only moved once since operation ; ordered a mild aperient.
19th.—No serious symptoms have arisen ; temperature run ning an almost uniformly normal course ; digestive system not disordered. Stump looks very well ; union has taken place between the flaps. Some superficial sloughing of anterior flap, but the granulations are healthy and vascular; posterior flap a little baggy, but the dressings are perfectly sweet ; salicylic cream is now used.
22nd.—No change worth noting since last report. A little pus can be squeezed out, which, however, is antiseptic, as shewn by absence of odour, and by the microscope.
27th.—Dressed again to-day ; stump in admirable condition ; parts entirely closed throughout; no signs of tension or bagging anywhere; external surface is pretty raw, from superficial excoriation of the integument; temperature varies from 98 to 990. Digestive system in good order.
29th.—( 21st day). Ordered up. Antiseptic dressings discontinued and red wash applied.
Nov. 4th.—Has been going about in the sick chair ; stump
Superior Maxillary Bones.- Recovery.—Under the care
(Reported by Mr. Thomas Gray.)
E. Z., aged 52, a French Canadian laborer, was admitted into the Montreal General Hospital in November of last year. He gave the following history : In the June previous he felt a severe pain in the second right molar tooth of the upper jaw. A small tumor soon formed round the tooth, which loosened and it fell out. The one next to this soon became affected in the same manner, and shared the same fate. The tumor continued to